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UESTIONNAIREQLIYAH A

For office use: File number: ___________ Date received: __________ Aliyah Shaliach: ___________________

Expected Aliyah Date: ___ /___/_____ Aliyah Representative: ___________________

This questionnaire is the basic document used for processing your Aliyah application. Please provide all of the relevant details, so that we can give you prompt attention and accurate information. Please write clearly in block letters; put an x or check the appropriate places; if a question is not applicable, please indicate this with "N/A". Questions regarding your background are designed to provide an overall picture that will help those assisting in your Aliyah preparation to anticipate your absorption needs. Some of this information is also used for statistical purposes. If you have any questions about filling in the application, please feel free to contact your local

You can find a list of toll free numbers at . Aliyah office or the Global Aliyah Center/English/org.jewishagency.www

ETAILSDERSONAL P –PPLICANT A

Please write your name as it appears in your passport

Last name: First name:

Maiden name (if applicable): Former names (if applicable):

Date of birth: _____/______/_______ (dd/mm/yyyy)

Gender: Male Female

Marital status: single married separated divorced widowed partners

Religion: Jewish other (specify)

Mother’s full name: Mother’s maiden name:

Father’s full name: Father’s former name (if applicable):

Israeli ID number (if applicable): Religious affiliation (check one or more): Orthodox Traditional Conservative

Progressive Reform Reconstructions Secular Other (specify)

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Country of birth: Nationality:

Additional nationality/ies (if applicable):

Passport # (including letters): Country issuing passport:

Country of residence (where you have lived in the year prior to your Aliyah):

Do you have a valid driving license? Yes No (In the country where you have lived in the year prior to your Aliyah)

Occupation:

Education: High school some college Bachelor’s Degree Master’s Degree

PhD Yeshiva other (please specify)

Have you been a member of youth organizations/ movements?

If so, which one(s):

Have you ever been to Israel? Yes No

Have you ever been: Israeli citizen, temporary resident, permanent resident,

Oleh, or none of these? If yes, what year(s)?

Have you ever owned a home in Israel? Yes No If yes, do you still own it? Yes No if no, when was it sold?

I have / have not spent more than 18 months in Israel in the past 3 years.

I have / have not spent more than 3 years in Israel in the past 7 years.

Have your parents ever lived in Israel? Yes No

Have your parents ever been Israeli citizens? Yes No

Have you served in the military? No Yes, IDF Yes, other (specify) ______________

FLUENTAS 5 , AS NONE0 WITH ,5 TO 0ROM ANK YOUR KNOWLEDGE FR -NOWLEDGEKEBREW H

Speaking reading writing

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DECLARATION - please check one

I declare that I have not committed any criminal offense.

I declare that I have not committed any act directed against the Jewish people or the security of the State of Israel.

There is no judicial warrant of arrest against me and I am not wanted by the police of any country.

I confirm that the information on this questionnaire is full and accurate, and has been provided in the awareness of the fact that it will serve as a basis for the consideration of my application. I will notify the Aliyah office of any changes occurring prior to my Aliyah

___________________________________________ Signature of Applicant

The aliyah questionairre was signed before ____________________________

Date:_____________________

___________________________________ Signature of Jewish Agency Representative

Please attach a photo and a photo of spouse (if applicable)

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SPOUSE – PERSONAL DETAILS

Please write your name as it appears in your passport

Last name: Firs name:

Maiden name (if applicable): Former names (if applicable):

Date of birth: _____/______/_______ (dd/mm/yyyy)

Gender: Male Female

Marital status: single married separated divorced widowed partners

Religion: Jewish other (specify)

Mother’s full name: Mother’s maiden name:

Father’s full name: Father’s former name (if applicable):

Israeli ID number (if applicable): Religious affiliation (check one or more): Orthodox Traditional Conservative

Progressive Reform Reconstructions Secular Other (specify)

Country of birth: Nationality:

Additional nationality/ies (if applicable):

Passport # (including letters): Country issuing passport:

Country of residence (where you have lived in the year prior to your Aliyah):

Do you have a valid driving license? Yes No (in the country where you have lived in the year prior to your Aliyah)

Occupation:

Education: High school some college Bachelor’s Degree Master’s Degree

PhD Yeshiva other (please specify)

Have you been a member of youth organizations/ movements?

If so, which one(s):

Have you ever been to Israel? Yes No

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Have you ever been: Israeli citizen, temporary resident, permanent resident,

Oleh, or none of these? If yes, what year(s)?

Have you ever owned a home in Israel? Yes No If yes, do you still own it? Yes No if no, when was it sold?

I have / have not spent more than 18 months in Israel in the past 3 years.

I have / have not spent more than 3 years in Israel in the past 7 years.

Have your parents ever lived in Israel? Yes No

Have your parents ever been Israeli citizens? Yes No

Have you served in the military? No Yes, IDF Yes, other (specify) ______________

FLUENTAS 5 , AS NONE0 WITH ,5 TO 0ROM ANK YOUR KNOWLEDGE FR -NOWLEDGEKEBREW H

Speaking reading writing

DECLARATION – please check one

I declare that I have not committed any criminal offense.

I declare that I have not committed any act directed against the Jewish people or the security of the State of Israel.

There is no judicial warrant of arrest against me and I am not wanted by the police of any country.

I confirm that the information on this questionnaire is full and accurate, and has been provided in the awareness of the fact that it will serve as a basis for the consideration of my application. I will notify the Aliyah office of any changes occurring prior to my Aliyah. .

___________________________________________ Signature of Applicant

The aliyah questionairre was signed before ____________________________

Date:_____________________

___________________________________ Signature of Jewish Agency Representative

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CHILDREN – Please list all children under age 25. In addition, children over age 18 who will be making Aliyah.

First and last name Date of birth

(dd/mm/yyyy)Gende

r Country of

birth

Israeli ID Number

(If applicable)

Is this child making

Aliyah with you?

M / F Yes / No

M / F Yes / No

M / F Yes / No

M / F Yes / No

M / F Yes / No

M / F Yes / No

M / F Yes / No

M / F Yes / No

M / F Yes / No

M / F Yes / No

M / F Yes / No

M / F Yes / No

Will the whole family be making Aliyah together? Yes No Do any of the above minor children have a parent who will not be making Aliyah? Yes No

CURRENT CONTACT DETAILS Address:

City: State: Zip: Country:

Home Phone: Email:

Work phone: Spouse work phone:

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Cell phone: Spouse cell phone:

PLANS UPON ARRIVAL IN ISRAEL Expected Aliyah date:

Expected place of residence:

Address: ________________________________________________________

Rental Relatives Other (please specify) __________________

Phone number in Israel:

Are you interested in being matched with a volunteer family to assist you through your initial

absorption period? Yes No

Contact in Israel:

Name and relationship:

Address (include city):

Phone number: